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. 2021 Oct 26;5(20):4064-4072.
doi: 10.1182/bloodadvances.2021004462.

Comparison of haploidentical and umbilical cord blood transplantation after myeloablative conditioning

John E Wagner  1 , Karen K Ballen  2 , Mei-Jie Zhang  3 , Mariam Allbee-Johnson  4 , Chatchada Karanes  5 , Filippo Milano  6 , Michael R Verneris  7 , Mary Eapen  4 , Claudio G Brunstein  1
Affiliations

Comparison of haploidentical and umbilical cord blood transplantation after myeloablative conditioning

John E Wagner et al. Blood Adv. .

Abstract

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has emerged as an important treatment modality. Most reports comparing haplo-HSCT with posttransplant cyclophosphamide (PTCy) and other donor sources have focused on outcomes in older adults treated with reduced intensity conditioning. Therefore, in the current study, we evaluated outcomes in patients with hematological malignancy treated with myeloablative conditioning prior to haplo- (n = 375) or umbilical cord blood (UCB; n = 333) HSCT. All haplo recipients received a 4 of 8 HLA-matched graft, whereas recipients of UCB were matched at 6-8/8 (n = 145) or ≤5/8 (n = 188) HLA antigens. Recipients of 6-8/8 UCB transplants were younger (14 years vs 21 and 29 years) and more likely to have lower comorbidity scores compared with recipients of ≤5/8 UCB and haplo-HSCT (81% vs 69% and 63%, respectively). UCB recipients were more likely to have acute lymphoblastic leukemia and transplanted in second complete remission (CR), whereas haplo-HSCT recipients were more likely to have acute myeloid leukemia in the first CR. Other characteristics, including cytogenetic risk, were similar. Survival at 3 years was similar for the donor sources (66% haplo- and 61% after ≤5/8 and 58% after 6-8/8 UCB). Notably, relapse at 3 years was lower in recipients of ≤5/8 UCB (21%, P = .03) compared with haplo- (36%) and 6-8/8 UCB (30%). However, nonrelapse mortality was higher in ≤5/8 UCB (21%) compared with other groups (P < .0001). These data suggest that haplo-HSCT with PTCy after myeloablative conditioning provides an overall survival outcome comparable to that after UCB regardless HLA match group.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Nonrelapse mortality and relapse. (A) The incidence of nonrelapse mortality after haploidentical relative (a), ≤5/8 (b), and 6-8/8 (c) UCB transplant. (B) The incidence of relapse after haploidentical relative (a), ≤5/8 (b), and 6-8/8 (c) UCB transplant.
Figure 2.
Figure 2.
Leukemia-free and overall survival. (A) The probability of leukemia-free survival after haploidentical relative (a), ≤5/8 (b), and 6-8/8 (c) UCB transplant. (B) The probability of overall survival after haploidentical relative (a), ≤5/8 (b), and 6-8/8 (c) UCB transplant.
See this image and copyright information in PMC

References

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